Obesity Risk in Infants Born to Women With Diabetes

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Results emphasize the importance of adequate recognition and timely treatment of maternal gestational diabetes to prevent fetal macrosomia in obstetrics.
Results emphasize the importance of adequate recognition and timely treatment of maternal gestational diabetes to prevent fetal macrosomia in obstetrics.

Body mass index (BMI) of infants born to mothers who have gestational diabetes may be 0.5 standard deviation score higher than that of the general Dutch background population. In addition, infants born large for gestational age (LGA) to mothers with type 2 diabetes (T2D) are at a higher lifetime risk for being overweight and becoming obese, according to a study published in Diabetologia. 

Researchers performed a study that included infants (N=104) born at the University Medical Center in The Netherlands over the course of 16 years (1990-2006) whose mothers had gestational diabetes. The purposes of this study were to assess differences in the growth trajectories of infants born non-LGA and LGA until early adolescence, and to assess whether the growth trajectories of infants born to mothers with T2D differed from those of infants born to mothers with type 1 diabetes (T1D).

Study results for height growth trajectories found no significant difference between non-LGA and LGA in the length of newborns during the first year of life; however, it was found that infants born LGA to mothers with gestational diabetes were slightly longer than infants born non-LGA to mothers with gestational diabetes. During years 1 through 14, height standard deviation scores for infants born to mothers with gestational diabetes were similar to those of children in the 2009 Dutch Growth Study, with a slight decrease observed in early adolescence.

The subgroup analysis of infants born LGA and non-LGA to mothers with gestational diabetes found different BMI growth patterns between these groups, but they were not statistically significant (P =.07). Infants LGA were observed to have a higher BMI standard deviation scores at 1 year that continued to increase until late childhood (8-10 years) when the score plateaued. A steady increase in BMI standard deviation score from years 1 through 14 was observed in infants born non-LGA to mothers with gestational diabetes. This was very similar to the pattern seen in the 2009 Dutch Growth Study.

In a further comparison between infants born to mothers with T1D and T2D, it was found that infants born LGA and non-LGA to mothers with gestational diabetes had a lower BMI standard deviation score than infants born to mothers with T2D, but higher than infants born to mothers with T1D. Infants born non-LGA to mothers with gestational diabetes had BMI standard deviation scores that were comparable to the 2009 Dutch Growth Study for those between the ages of 1 and 14 years. Overall, infants born to mothers with T2D for both non-LGA and LGA were found to have the highest BMI standard deviation score.

Researchers concluded that the infants born to women with gestational diabetes overall had a limited risk for becoming overweight, with an average BMI score in early adolescence of +1, with slightly higher values than children in the 2009 Dutch Growth Study. When compared with the infants born to women with T1D, infants born to women with T2D were found to have the highest risk (+1.6 standard deviation score higher) for childhood obesity developing until the age of 14, when the risk increased to +2. 

Clinicians should consider the risk for obesity in infants born to women with gestational diabetes carefully, especially those born LGA, and initiate obesity preventive measures early and whenever possible (ie, lifestyle coaching, nutrition, exercise).

Reference

Hammoud NM, Visser GHA, van Rossem L, Biesma DH, Wit JM, de Valk HW. Long-term BMI and growth profiles in offspring of women with gestational diabetes. Diabetologia. 2018;61(5):1037-1045.

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